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A railway worker for Network Rail was hit by a train while on the job on Jan. 22, 2014 and died a few days later on Jan. 31. Investigators suggest that John Wright believed the train was heading down a different platform, so he was caught off guard. After an investigation, the Rail Accident Investigation Branch has issued guidance to Network Rail for safety failures.

The RAIB report says that Wright moved to a safe area after the train blew its warning horn. He should have stayed in that position until he was given permission to move again by the controller of site safety. Unfortunately, the COSS was not there at the time that Wright was hit by the train. Investigators say that it is likely Wright believed the train was going to keep going straight to a different platform.

CCTV footage shows that Wright didn’t even turn to look at the train when it blew its second warning horn. He didn’t turn to face the train until it was too late, so he was unable to take any kind of evasive action.

Although Wright had worked with trains for nearly 30 years, he had been involved in two other safety incidents. In fact, one of these incidents happened in the month before he was hit by the train. The investigation into his death showed that the injuries he suffered in the train accident involved his face, chest and pelvis.

In addition to its findings about the train accident, the RAIB also found insufficient enforcement of safety discipline in the area of the incident. It has suggested that Network Rail increase safety training efforts and improve protection procedures. Network Rail said that it will consider and look into the findings that have been brought to light by the RAIB.